20-1406. Prohibiting denial of certain
contract benefits
A. Notwithstanding any provision of any group disability insurance contract or
blanket disability insurance contract, benefits shall not be denied under the contract
for any medical or surgical service performed by a holder of a license issued pursuant to
title 32, chapter 7 or 11 or a registered nurse practitioner who is licensed
pursuant to title 32, chapter 15, if the service performed is within the lawful scope of
such person's license, and if the service is surgical, such person is a member of the
staff of an accredited hospital, and if such contract would have provided benefits if
such service had been performed by a holder of a license issued pursuant to title 32,
chapter 13.
B. If any group disability insurance contract or blanket disability insurance
contract provides for or offers eye care services, the subscriber shall have freedom of
choice to select either an optometrist or a physician and surgeon skilled in diseases of
the eye to provide the examination, care, or treatment for which the subscriber is
eligible and which falls within the scope of practice of the optometrist or physician and
surgeon. Unless such group disability insurance contract or blanket disability insurance
contract otherwise provides, there shall be no reimbursement for ophthalmic materials,
lenses, spectacles, eyeglasses, or appurtenances thereto.
C. If any group disability insurance contract is written to provide coverage for
psychiatric, drug abuse or alcoholism services, reimbursement for such services shall be
made in accordance with the terms of the contract without regard to whether the covered
services are rendered in a psychiatric special hospital or general
hospital. Reimbursement for the cost of the service may be made directly to the person
licensed or certified pursuant to title 32, chapter 13 or 19.1 or to the subscriber if
the cost of the service has not been reimbursed to another provider or health care
institution.
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